IAPAC/EHNN Conference Mental health as a facilitator and barrier to optimal HIV care

Size: px

Start display at page:

Download "IAPAC/EHNN Conference Mental health as a facilitator and barrier to optimal HIV care"

Valentine Evans
5 years ago
Views:

1 IAPAC/EHNN Conference Mental health as a facilitator and barrier to optimal HIV care Shaun Watson Community HIV CNS (Westminster London) November 2016

2 What are we talking about Stress and Anxiety Depression Borderline Personality Disorder Bipolar Disorders Post Traumatic Stress disorder Schizophrenia Substance Use Neurocognitive Disorders

3 Along the care continuum HIV testing and diagnosis Linkage to and retention in primary HIV care Receipt and adherence to antiretroviral therapy (ART) Retention in care is essential, it provides opportunities to monitor response to ART and general health and prevent ART and HIVassociated toxicities and complications.

4 What are the Barriers? Complexity Competing Life activities Delays in Accessing Care Lack of Patient Friendliness Feeling sick Stigma Substance Abuse

5 Good Mental Health & HIV Having self worth have accepted HIV = better adherence Open disclosure = better support Positive relationships partner, healthcare, children Having faith in treatment Simple regimen Medication taking priority over substance use Seeing positive results more energy

6 Mental Health & HIV Fear of disclosure Fear of treatment taste, size, dosing, pill burden Feeling depressed, hopeless or overwhelmed Having a concurrent addiction Forgetting to take medication Suspicions about treatment wanting to be free of treatment Lack of self-worth not bothered if they live or die Reminder of HIV status

7 Case Study - Maria Maria, 69, Portuguese (in UK 45 years). Lives alone HIV positive since 1994 Currently not taking ARV s (Truvada, Darunavir/Ritonavir) cd4 124, VL 45,000 Known hypertension not taking medication Referred to Community HIV CNS for support and management of adherence

8 Maria 2 Obvious mental health issues delusional and paranoia (blames housing association for her poor health, states they are watching her and have bugged her phone) Isolated has 3 children who live across Europe, no friends. Hoarding collects vintage clothes and accessories but states has no money for food

9 Maria - Plan Housing contact housing association to remedy immediate issues Support refer for a support worker to arrange bills, debt, transport Health move GP, monitor her blood pressure, discuss ARV s and dosette to monitor adherence. Visit every 2 weeks

10 Case Study - Charles Charles, Danish (lived UK 35 years) 54 Diagnosed HIV positive in 2014, late diagnosis (cd4 50). Hospitalised for 12 weeks Prior to diagnosis known to mental health services saw CPN weekly, psychiatrist every 2 months for personality disorder and anxiety Discharged home with care package Seen by HIV CNS weekly

11 Charles 2 Commenced Raltegravir, Ritonavir, Truvada Lives alone, no immediate family in UK (father dying). Set routine, goes to bed at every day. Forms relationships very quickly (attachment issues) States that he has no friends but attends Buddhist centre three times a week, hospice/hiv daycare once a week.

12 Charles - Plan Weekly visits every 2 weeks now monthly Does not see CPN or Psychiatrist feels he gets support from Community CNS & HIV drop in Support offered around HIV (embarrassed), ART would prefer single tablet, erectile dysfunction and impotence, worries around Brexit!

13 Challenges Mental health Services have set boundaries and will/may only offer support to those with well defined mental health issues. It is difficult to get support if the issue is thought to be organic related to HIV. Difficult if the patient does not acknowledge the problem! Complicated by drug and alcohol use.

14 What can we do? Discuss - what are the issues? Identify them and see what can be done to Change this may mean being flexible with appointments Support regular contact, community support, peer support, advocacy Integrated care!

15 and Finally Retention in care is a critical element of the HIV care continuum and is necessary for successfully managing HIV infection. Developing care models where social and financial barriers are routinely assessed and addressed, mental health and substance abuse treatment is integrated, and patientfriendly services are offered

16 References 1. Bauman, L.J., Braunstein, S., Calderon, Y., Chhabra, R., Cutler, B., Leider, J., Rivera, A., Sclafane, J., Tsoi, B. and Watnick, D., Barriers and facilitators of linkage to HIV primary care in New York City. Journal of acquired immune deficiency syndromes (1999), 64(0 1), p.s Mills, E.J., Nachega, J.B., Bangsberg, D.R., Singh, S., Rachlis, B., Wu, P., Wilson, K., Buchan, I., Gill, C.J. and Cooper, C., Adherence to HAART: a systematic review of developed and developing nation patientreported barriers and facilitators. PLoS Med, 3(11), p.e Tso, L.S., Best, J., Beanland, R., Doherty, M., Lackey, M., Ma, Q., Hall, B.J., Yang, B. and Tucker, J.D., Facilitators and barriers in HIV linkage to care interventions: a qualitative evidence review. AIDS, 30(10), pp Yehia, B.R., Stewart, L., Momplaisir, F., Mody, A., Holtzman, C.W., Jacobs, L.M., Hines, J., Mounzer, K., Glanz, K., Metlay, J.P. and Shea, J.A., Barriers and facilitators to patient retention in HIV care. BMC infectious diseases, 15(1), p.1.

CCTs and HIV care: Preliminary results and priority areas for intervention

CCTs and HIV care: Preliminary results and priority areas for intervention Harsha Thirumurthy, Ph.D. Gillings School of Global Public Health UNC-Chapel Hill Outline 1. Background on HIV treatment, adherence